Transcript 3QFY16 EPRP UPDATE.ppsx

EPRP UPDATE
3Q FY2016
Objectives
• The purpose of this presentation is to
▫ Provide an overview of 3Q changes to EPRP data
collection instruments
▫ Provide an overview of 3Q changes to EPRP
measure scoring
▫ Reiterate rules for some questions that have not
changed
CGPI Changes
• We will start with a look at the changes to CGPI
• Only a few modules have changes
▫ Mental Health
▫ OP Medication Reconciliation
▫ Prevention
Mental Health Module
• The only change in the mental health module is the
addition of Clinical pharmacist
(RPH/PharmD) as an acceptable provider in
the following questions
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alcbac
deprsk
depeval
depmhevl
ptsdrisk
ptsdeval
ptsdmhevl
Outpatient Medication Reconciliation
• The question medrenew has been removed
▫ It is no longer needed as an exclusion to mrec27
• There are two important changes to question 7,
opmedlst
▫ Option 3 has been removed (Documented medications were not
prescribed or changed during the most recent outpatient clinic
visit)
▫ If the patient refused the written list of reconciled
medications, select “1.”
Prevention Module
• All questions related to hepatitis c testing have
been removed
• All communication of test results questions have
been removed
No Changes
• There are no changes to the Validation, CVD,
Core, DM, or Shared modules
• Please note this reminder for DM module
question eyespec
▫ If the patient was seen by an eye care specialist
outside VHA and it is known the eye exam was
accomplished (i.e. documentation the funduscopic
or retinal exam was done by eye care specialist,
date of exam, and result of exam), but the specialty
is unknown, use response “1” as default.
CGPI Exit Report and Scoring
• Note the following changes on the CGPI exit report
▫ cvrm1 and cvrm2 are now bolded measures (eligible
for reconsideration)
▫ The influenza immunization measures will be scored
beginning with the April study interval (5/9 pull list)
 p25h
 p26h
 p19s
Medication Education
• A new question has been added to the series of
HBPC medication education questions
• Q15 medclindt
▫ Enter the date of the most recent HBPC encounter
by a physician/APN/PA during the past year.
 A face to face or telephone encounter by a
physician/APN/PA during the past year is acceptable.
 Enter the exact date of the most recent HBPC encounter
by a physician/APN/PA during the past year.
 If there is no documentation of a HBPC encounter by a
physician/APN/PA during the past year, enter
99/99/9999.
• This question replaces medrxdt
newmedrx
• Question 16, newmedrx, has been revised
▫ During the most recent HBPC encounter* by a
physician/APN/PA on (computer to display
medclindt), was a new medication prescribed or
added to the medication list?
 Remember that the encounter may be face to face or
by telephone
newmedrx
• The definition of new medication has been revised for
clarification
▫ any VA prescription, non-VA prescription, OTC or
herbal/nutritional supplement
▫ that has been prescribed by a VA or non-VA provider (or
started by the patient/caregiver)
▫ since the most recent medication reconciliation completed by
a HBPC staff member prior to this visit,
▫ OR addition of a new medication at this visit
• For the purpose of this question, exclude medical and diagnostic test
supplies (e.g., glucometer strips, gauze, syringes, etc.).
Outcome of cognitive screen
• Please note the clarification in the
definition/decision rules for question 26 cogout
▫ Documentation of cognitive assessment tool score
only is not sufficient (e.g., CPCOG score = 8) to
answer “1.”
• You should expect to see documentation such as
▫ Results not indicative of cognitive impairment
▫ Results indicate mild cognitive impairment
▫ Results within normal limits
HBPC Exit Report and Scoring
• mrec 37
▫ The new question medclindt is included in scoring
of hc37
▫ If the answer is 99/99/9999, the case is excluded
Hospital Outpatient Measures
• There are no changes to the HOP instrument or
scoring
HBIPS
• The format of the admission screening questions
has been modified
▫ q10 admscrn provides general guidelines for
answering all the admission screening questions
▫ the individual requirements for each of the six
subsequent questions are emphasized in the
definition/decision rules
• Please take time to review both the general
guidelines as well as the rules for each admission
screening question
Admission Screening Reminder
• It is critical to review the rules for each
component of admission screening and be
certain that documentation meets the timeframe
specified, i.e during the past 12 months for
substance use and alcohol use, during the past 6
months for risk of violence to self and others
HBIPS Exit Report and Scoring
• There is a change to the HBIPS exit report
format
▫ Ips4a, ips5a and ips7a are no longer bolded (i.e.
not eligible for reconsideration)
Revisions
• Please review all highlighted sections in the
Global instrument
• While there really is no new information, there
are some clarifications
• In some cases the definition/decision rules have
been reformatted in an attempt to call your
attention to important points
Acute Care
• Remember that the Global instrument applies to
discharges from acute inpatient care
• Sometimes cases are in the Global sample but
are not acute inpatient stays
▫ Residential Rehabilitation (psych, substance
abuse)
▫ Admissions for rehabilitation, such as blind rehab
Acute Care
• It is always a good idea to look at EADT (under
the reports tab) to determine whether the
admission on your pull list is for acute inpatient
care
• If a case on your list is not an acute inpatient
admission, leave it blank and enter the reason
why
▫ If you have already opened the record, you will
need to ask your RM to return the case to blank
status
Additional Questions
• We have been working with ABI on feasibility of
using data captured by Emergency Department
Integrated Software (EDIS) for Emergency
Department (ED) timing measures.
• Historically, we have found abstraction of some
ED data elements to be challenging related to
complicated abstraction guidelines and
documentation in the medical record.
Additional Questions
• For the April 11, 2016 Global Pull List only, 12
questions have been added to the Global
Instrument to capture location of the data
source for six ED date and time questions.
• We will complete an analysis of the abstracted
data to include a comparison with data provided
by ABI.
Arrival Date and Time
• q1 and q4
• Capturing the earliest acute care arrival date
generally is not a problem but quality
control/IRR data shows us that accurately
abstracting the earliest arrival time is more
of a challenge
Arrival Date and Time
• Please review the rules for arrvdate and arrvtime
carefully
• Remember that you may need to look at more
than one source in the medical record to capture
the earliest time the patient arrived in the acute
care setting
▫ Review the suggested priority sources for finding
the earliest arrival time
Earliest Arrival Time
• For example
▫ the ED Triage note states “Time of Arrival: 11:06”
▫ Past clinic visits (CVP) shows that the patient was
signed into the ED at 11:02
▫ Vital signs were done at 11:07
▫ Enter 11:02 as the acute care arrival time
New Questions
• Following arrvdate and arrvtime you will find
new questions asking you to select the location
where the earliest arrival date and arrival time
were found in the medical record
Q2 larrvdt
• Select the location where the earliest arrival date
was found in the medical record.
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1. Emergency Department note
2. Expanded admission/discharge/transfer (EADT)
3. Nursing admission assessment
4. Observation notes
5. Outpatient registration form
6. Past clinic visits
7. Procedure note
8. Scanned document (VISTA imaging)
9. Triage note
10. Vital sign record
11. Other
Other location
• If you select option 11 “other”, you will type the
name of the other location where you found the
earliest arrival date in a text field (q3, oarrvdt)
▫ If the location is a note, enter the name of the local
note title
• The same questions are repeated for arrival time
Decision to Admit
• q16 and q19
• The definition/decision rules for decision to
admit have been re-formatted to emphasize
important points for accurate abstraction of the
earliest decision to admit date and time
• Please review the rules and the example
provided
Decision to Admit Time
• For narrative documentation that clearly refers
to the decision to admit to observation/inpatient
status or that patient will be going to cath lab or
surgery, take the initial note time unless there is
a later time specified within that note.
Decision to Admit Time
▫ EXAMPLE: If the time of the decision to admit is
available in the provider’s note, compare it with
the admission order time and take the earliest
time.
▫ If there is not a decision time in the provider’s
note, but it does document a plan to admit the
patient, use the start time of that note and
compare it to the admission order time and use
the earliest time.
Location of Decision to Admit Date and
Time
• q17,18, 20,21
• New questions have been added after decision to
admit date and decision to admit time to capture
the location of the data
Q17 ldecdt
• Select the location where the earliest
documented date of decision to admit was found
in the medical record.
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ED disposition note
ED physician/APN/PA note
ED physician order
Other
Decision to admit location
• If you select the “other” option for decision to
admit date location you will enter the location in
the text box (q18)
• You will enter the location of decision to admit
time in q20
ED Departure Time
• Q25 edctm
• Please review the definition/decision rules for
abstracting ED departure time
• Remember that the intent of the data element is to
capture the latest time at which the patient was
receiving care in the ED
• A departure time listed within a Disposition heading
in the ED record may be used
▫ If the actual time of departure is not documented
within this note, the signature time of the note may be
entered
Location questions
• Q23, 24, 26 and 27 are new questions that
capture the location of the documentation of the
date and time of ED departure
Pneumococcal ImmunizationReminder
• q28 vaxstat
• There are no changes to this question or rules
but….
• Please be reminded that you should look in the
record for all other VAMCs at which the veteran
has received care to see if pneumococcal
immunization was administered in the past
Influenza Immunization
• q29 flustat
• There are no changes to the flustat question but a couple of
reminders are warranted
• To select option 1, you must see that the flu immunization was given
during the admission under review
▫ Remember that BCMA is one of the suggested data sources for
documentation of influenza immunization
 You may see that the immunization was given or refused
 If the letter “R” precedes the administration time, that indicates the
immunization was refused
Influenza Immunization
• q29 flustat
• To select option 2, you must see that the immunization was given
prior to admission during the current influenza
immunization season
▫ If the veteran was seen at another VAMC during the
immunization season, please remember to review notes at that
facility to look for documentation that the immunization was
given
Influenza Immunization
• In order to select option 4, the only acceptable
conditions/reasons are those specifically listed
 Allergy/sensitivity to influenza vaccine, anaphylactic
latex allergy, or anaphylactic allergy to eggs, OR
 is not likely to be effective because of bone marrow
transplant (or autologous stem cell transplant,
ASCT) within the past 6 months, OR
 prior history of Guillain-Barre syndrome within 6
weeks after a previous influenza vaccination
Tobacco Cessation Medications
• q33
• When answering the question tobtxmed, be sure
to look in BCMA for verification that tobacco
cessation medications were given during the
applicable time frame
▫ If the letter “R” precedes the administration time,
that indicates the medication was refused
▫ You may also see “RM” indicating a patch was
removed
Referral for OP Tobacco Cessation
Counseling
• Q35 refobtob
• Please review the definition/decision rules
• Clarification regarding Quitline referrals has
been added
• A Quitline is defined as telephone counseling in
which at least some of the contact is initiated by
the Quitline counselor to deliver tobacco use
interventions.
Referral for OP Tobacco Cessation
Counseling
• If a Quitline referral is made, there must be
documentation an actual referral was made.
Providing a Quitline phone number is
NOT sufficient to answer “1”.
▫ For Quitline referrals, the healthcare provider or
hospital can either fax or e-mail a Quitline referral
or assist the patient in directly calling the
Quitline prior to discharge.
▫ If only a Quitline number is provided to the
patient with no formal referral/consult placed,
select “2”.
Global Exit Report
• There are changes to the Global exit report
format
▫ imm1, sc1all and sc2all are no longer bolded (i.e
not eligible for reconsideration)
Arrival Date and Time
• The rules for arrival date and time in the Stroke
instrument have been reformatted as previously
noted in the slides for Global Measures
Reason for Oral Factor Xa
• q30 oralxai
• The definition/decision rules have been revised
to clarify that the only acceptable reasons do not
have to be linked to administration of Oral
Factor Xa for VTE prophylaxis
Stroke Discharge Instructions
• The general guidelines that apply to all 5
discharge instruction questions are addressed in
#40 ptedstk
▫ Please review the guidelines carefully
• Specific instructions for abstracting each
component are addressed in the subsequent
questions
Stroke Exit Report
• There are no changes to the Stroke Exit Report
or scoring
Revisions for Clarification, Emphasis
• Revisions have been made to the
definition/decision rules for a few questions to
provide clarification and/or for emphasis
• Please review all the highlighted areas
VTE Discharge Instructions
• The general guidelines that apply to all 4
components of VTE discharge instructions are
addressed in #43 ptedvte
• The subsequent questions address specific
abstraction rules for each component
• Please review thoroughly both the general
guidelines and the rules for each component.
VTE Exit Report, Scoring
• vte1, 2 and 3 are no longer bolded on the exit
report
Delirium Risk
• There are no changes to the Delirium Risk
questions or rules
Inpatient Medication Reconciliation
• The revisions to the Inpatient Medication
Reconciliation module are for clarification
• q1 revptmed:
▫ In order to select 1 (yes) there must be evidence of
patient/caregiver involvement in the review of the
medication list
Inpatient Medication Reconciliation
• q4 noptlist3
▫ Select option 4 if the patient was referred from
another facility (e.g. SNF, Assisted Living, etc) and
no attempt was made to obtain the patient’s
medication list from that facility
▫ Select option 5 if the patient was not referred from
another facility
q7 medsame2
• In order to answer the medsame2 question
accurately it is necessary to do a thorough
comparison of the discharge medication list
given to the patient and the list of discharge
medications in the discharge summary
• Simply counting the medications or taking a
cursory look is not adequate to determine if the
medication lists are the same
Combined Cohort Exit Report
• There are some changes to the Combined Cohort
Exit report
• mrec42 is no longer bolded
• mrec27 (Reconciled Medication List Provided to
Patient) has been changed to mrec43
▫ The exclusion for renewal as the only medication
action has been removed, otherwise scoring is the
same
• Fe81 has been corrected to read: Hospitalized
patients >= 65 identified at risk for delirium
References and Resources
• Please remember to utilize the references and
resources that are available to assist you with
accurate data collection
▫ Data collection questions
▫ Exit report guides
▫ WVMI EPRP Staff
Data Collection Questions
• You already know that the questions and
associated definition/decision rules are available
in the data collection software as well as the
printed version we send at the beginning of each
quarter
• The importance of reading and following the
rules for abstraction cannot be overstated-it is
the key to accurate data
Data Collection Questions
• Did you know that the question sets are also
available on the WVMI website?
• The facility liaison can access the questions there
• The quarterly update PPT is also posted on the
website
Exit Report Guides
• The exit report guides that are sent to you by
email are also available as a resource for the
liaisons on the website
• It is important to remember that the exit guides
help you to interpret the scoring but should not
be used to guide abstraction…the
definition/decision rules are the guide for
abstraction
WVMI Staff
• Your Regional Manager is your first contact for
questions
• Asking questions as needed is another key to
accurate abstraction
• If you are unable to answer scoring questions
ask for help so that you can provide the facility
with correct information and guidance
Thank you!
• Thank you for taking time to review this
presentation and the question sets
• Be sure that you have the presentation open
while completing the Learning Assessment